Given the continuing unpopularity of the Affordable Care Act and the possibility of the Supreme Court ruling it unconstitutional later this year, some see an opportunity to do away with the health care reform legislation in Massachusetts that inspired the ACA. Given the state’s politics, though, such an effort will be much more difficult than the campaign to undermine the ACA.

In 2006, Republican Gov. Mitt Romney signed into law a bill establishing sweeping health care reform in the Bay State. Although different in key respects, the ACA also has many similarities to this state health care reform bill. This bipartisan legislation included an individual mandate, a new agency to facilitate the purchasing of health insurance, subsidies for individuals to purchase insurance, and penalties on businesses that do not offer insurance to their employees.

According to a 2011 Boston Globe poll, 63 percent of Massachusetts residents support the health care reform law. But some opponents of the Massachusetts law see an opportunity to capitalize on a Supreme Court decision overturning ACA.

Opponents of Law See Opportunity

According to Carla Howell, current executive director of the national Libertarian Party and a former Libertarian candidate for U.S. Senator and governor in Massachusetts, many in the Bay State are strongly in favor of getting rid of the health care law, which some have dubbed “Romneycare.”

“Libertarians, Tea Partiers, and rank-and-file Republicans are very displeased and would like to see Romneycare repealed,” says Howell. “A number of them are working to unseat the GOP leadership in Massachusetts. If they succeed, or if a repeal measure gets on the ballot, Romneycare could go down.”

Josh Archambault, director of health care policy for the Pioneer Institute, notes any movement to repeal the law will have to come from the grassroots. Among the state’s GOP elected officials, he says, the “rhetoric has not been repeal.”

In fact, Archambault doesn’t see much chance of a voter-led revolt.

“I don’t anticipate any time in the near future the law being repealed by the voters. That doesn’t mean the legislature won’t tweak things,” he says.

Howell disagrees. “A group of strong candidates running for office coupled with activists who want to repeal Romneycare can get it on the ballot, campaign on it, and very possibly wipe it off the books before it bankrupts the people and small businesses of Massachusetts,” she said.

Costs Continue to Concern State

One weakness of the law that could prove its undoing is its cost, and Massachusetts’ continuing rise in premiums. In a chapter for a recently released book discussing the Massachusetts reform in great detail, The Great Experiment, Archambault and coauthor Amy Lischko note that “most individuals, employers, and the government did not experience any cost savings since the reform was implemented.”

A 2011 study by the Beacon Hill Institute concurs. According to the study, “Few of the increased costs identified in this study have been shifted to the Commonwealth primarily because the federal government, through its Medicaid waiver agreement, has absorbed a large portion of the cost increases.”

While noting the Massachusetts law predates Obama’s law and any Supreme Court ruling on its constitutionality will not affect it directly, Howell points out the cost to taxpayers remains a key weakness and could ultimately prove its undoing. Democratic Gov. Deval Patrick’s administration has already discussed dramatically expanding the power of the state government to control prices in response to these budget challenges.

“Romneycare could also become insolvent and severely defunded or repealed if federal politicians stop bailing it out, as they've been doing since its inception,” she said.

In any case, the fate of the Massachusetts law doesn’t hinge on what happens to ACA. As Archambault points out, repeal of ACA “doesn’t change things at a fundamental level.” The future of the Bay State law therefore remains up to the people and politicians in Massachusetts.